Rosacea

Question 1

What is Rosacea?

Answer 1

• Rosacea is a chronic inflammatory skin condition
• Predominantly affecting the central face
• Often starts between the age of 30-60 years

Question 2

What are some of the causes of Rosacea?

Answer 2

• Genetic Association
• Altered microbiome of the skin and gut (bacterial overgrowth of the small intestine, H-pylori and Staph Epidermis)
• Dysregulation of the immune response may lead to excessive inflammation, vasodilation, lymphatic dilatation and angiogenesis
• UV radiation ( sunlight exposure makes Rosacea worse)
• Temp Changes
• exercise
• spicy foods
• alcohol
• psychological stress
• air pollution and tobacco smoking

Question 3

What are some of the Cutaneous Features of Rosacea?

Answer 3

• Transient recurrent erythema = Flushing red
• Persistant facial erythema
• Telangiectasia (facial skin, eyelid margin telangiectasia)
• Inflammatory papules and pustules (papulopustular)
• Phymatous changes

Question 4

What are Phymatous Changes?

Answer 4

• Thickening of the skin due to hyperplasia/fibrosis of the sebaceous glands of the face
• Most common area affected is the nose

Question 5

What is Morbihan Disease?

Answer 5

• Rosacea induces facial lymphoedema, producing redness and swelling of the face and lids

Question 6

What is Neurogenic Disease?

Answer 6

• Facial tenderness, burning pain accompanied by redness and flushing

Question 7

What are some of the Ocular features associated with Rosacea?

Answer 7

• Dryness
• Foreign-body sensation
• Photophobia
• Conjunctivitis
• Blepharitis
• Keratitis - long-term eyesight impairment

Question 8

How do you diagnose Rosacea?

Answer 8

• Persistant centrofacial erythema associated with periodic intensification by potential trigger factors
• Phymatous changes

Question 9

What is the major criteria for Rosacea?

Answer 9

• Flushing/ transient centrofacial erythema
• Inflammatory papules and pustules
• Telangiectasia - visible blood vessels
• Ocular Rosacea

Question 10

What are the minor features of Rosacea?

Answer 10

• Burning sensation of the skin
• Stinging sensation of the skin
• Oedema
• Dry sensation of the skin

Question 11

What is the Differential Diagnosis for Rosacea?

Answer 11

• Acne Vulgaris
• Eczema
• Drug reaction
• Seborrhoeic Dermatitis
• SLE

Question 12

What is the Management for Rosacea?

Answer 12

• Simple Measures
• Predominant erythema/flushings
• Mild-to-moderate papules/pustules
• Moderate-to-severe Papules/ Pustules

Question 13

What are the simple measures for Rosacea?

Answer 13

• Recommend daily application of a high-factor sunscreen
• Camouflage creams may help conceal redness

Question 14

What is the managment for Predominant Erythema/Flushing?

Answer 14

• Topical Brimonidine gel (alpha-adrenergic agonist) - predominant flushing but limited telangiectasia
• Used as required - reduce redness
• Reduces redness within 30mins, reaches peak at 3/6 hours

Question 15

What is the managment for mild-to moderate papules/pustules?

Answer 15

• 1st line: topical ivermectin
• Alternatives: topical metronidazole or topical Azelaic acid

Question 16

What is the managment for moderate-to-severe papules and pustules?

Answer 16

• Topical Ivermectin + oral Doxycycline

Question 17

When should you refer for Rosacea?

Answer 17

• If symptoms have not improves with optimal managment in primary care
• laser therapy may be appropriate for patients with prominent telangiectasia
• Patients with a Rhinophyma

Question 18

What is Rhinophyma?

Answer 18

• Disfiguring nose due to proligeration of the sebacceous glands

Question 19

What is Rosacea?

Answer 19

• A chronic inflammatory skin condition